CAJ | 학술논문

目的：探讨早期连续性肾脏替代治疗（CRRT）对严重脓毒症急性肾损伤（AKI）患者的作用。方法采用前瞻性研究方法，选择2009年10月至2013年6月广东省清远市人民医院重症监护病房（ICU）收治的严重脓毒症导致AKI的160例患者为研究对象。按CRRT时间分为早期治疗组及常规治疗组，每组80例。所有患者均按照严重脓毒症的集束化原则治疗。早期治疗组尿量＜0.5 mL?kg-1?h-1，持续治疗超过6 h疗效不理想时，即开始接受CRRT；常规治疗组尿量＜0.5 mL?kg-1?h-1，持续治疗超过24 h或首次出现难以纠正的酸中毒、心力衰竭（心衰）才开始行CRRT。比较两组患者尿量、肌酐、血氧饱和度、白蛋白等指标的变化，以及28 d生存率、ICU住院时间、器官支持时间等生存资料，评价早期CRRT对患者的治疗意义。结果早期治疗组ICU平均住院时间（d：6.5±1.7比8.2±1.6）、器官支持时间（d：5.3±1.8比6.0±1.4）、尿量恢复时间（d：3.4±0.9比4.8±0.5）均明显短于常规治疗组（均P＜0.01）；1周内尿量恢复比例明显高于常规治疗组（46.2%比28.8%，P＜0.05）；1周内肌酐恢复比例低于常规治疗组（55.0%比78.8%），但差异无统计学意义（P＞0.05）；早期治疗组和常规治疗组肌酐恢复时间相当（d：5.1±1.3比5.2±1.2）；早期治疗组28 d生存率高于常规治疗组（41.2%比35.0%），但差异无统计学意义（P＞0.05）。结论早期CRRT未能显著改善严重脓毒症AKI患者的预后，但有利于患者尿量的早期恢复，缩短ICU住院时间、器官支持时间及透析时间。
목적：탐토조기련속성신장체대치료（CRRT）대엄중농독증급성신손상（AKI）환자적작용。방법채용전첨성연구방법，선택2009년10월지2013년6월광동성청원시인민의원중증감호병방（ICU）수치적엄중농독증도치AKI적160례환자위연구대상。안CRRT시간분위조기치료조급상규치료조，매조80례。소유환자균안조엄중농독증적집속화원칙치료。조기치료조뇨량＜0.5 mL?kg-1?h-1，지속치료초과6 h료효불이상시，즉개시접수CRRT；상규치료조뇨량＜0.5 mL?kg-1?h-1，지속치료초과24 h혹수차출현난이규정적산중독、심력쇠갈（심쇠）재개시행CRRT。비교량조환자뇨량、기항、혈양포화도、백단백등지표적변화，이급28 d생존솔、ICU주원시간、기관지지시간등생존자료，평개조기CRRT대환자적치료의의。결과조기치료조ICU평균주원시간（d：6.5±1.7비8.2±1.6）、기관지지시간（d：5.3±1.8비6.0±1.4）、뇨량회복시간（d：3.4±0.9비4.8±0.5）균명현단우상규치료조（균P＜0.01）；1주내뇨량회복비례명현고우상규치료조（46.2%비28.8%，P＜0.05）；1주내기항회복비례저우상규치료조（55.0%비78.8%），단차이무통계학의의（P＞0.05）；조기치료조화상규치료조기항회복시간상당（d：5.1±1.3비5.2±1.2）；조기치료조28 d생존솔고우상규치료조（41.2%비35.0%），단차이무통계학의의（P＞0.05）。결론조기CRRT미능현저개선엄중농독증AKI환자적예후，단유리우환자뇨량적조기회복，축단ICU주원시간、기관지지시간급투석시간。
Objective To evaluate the effect of early continuous renal replacement therapy(CRRT)on patients with acute kidney injury(AKI)induced by severe sepsis. Methods A prospective study was conducted. 160 patients with AKI induced by severe sepsis admitted to intensive care unit(ICU)of Qingyuan People's Hospital between October 2009 and June 2013 were enrolled. According to the starting time of CRRT,the patients were randomly divided into two groups:an earl y treatment group and a regular treatment group(each,80 cases). All patients were treated in accordance with the principle of the cluster of severe sepsis. In early treatment group,the patents began to receive CRRT when the amount of urine output was<0.5 mL?kg-1?h-1 and had taken continuous conventional treatment over 6 hours,but the curative effect was not ideal. In the regular treatment group,the patients began to apply CRRT when the amount of urine output was<0.5 mL?kg-1?h-1 and had taken continuous conventional treatment persistently over 24 hours or difficultly corrected acidosis or heart failure developed. The changes in urine output,creatinine,saturation of blood oxygen,and albumin,and 28-day survival rate,length of ICU stay,time of organ support were measured and compared between the two groups to evaluate the therapeutic significance of the early CRRT. Results The mean length of ICU stay(day:6.5±1.7 vs. 8.2±1.6),length of organ support(day:5.3±1.8 vs. 6.0±1.4),the recovery time of urine amount(day:3.4±0.9 vs. 4.8±0.5)in early treatment group were significantly shorter than those in regular treatment group(all P<0.01);recovery ratio of urine in 1 week in early treatment group was significantly higher than that in regular treatment group(46.2%vs. 28.8%,P<0.05). The creatinine recovery ratio in 1 week in early treatment group was lower than that in regular treatment group(55.0%vs 78.8%),but there was no statistically significant difference(P>0.05). Early treatment group and regular treatment groups of creatinine recovery time were similar(day:5.1±1.3 vs. 5.2±1.2). 28-day survival rate in early treatment group was higher than that in regular treatment group(41.2%vs. 35.0%),but there was no statistically significant difference(P>0.05). Conclusion It is found that there is no evidence to suggest that early CRRT may improve the prognosis of the patients with AKI induced by severe sepsis,but it may be in favor of shortening the time of urine recovery,length of stay in ICU,length of organ support and length of dialysis.